Mishra P, et al. - In this crossover study of 18 primary care physicians, researchers assessed whether the use of medical scribes decreased electronic health record (EHR) documentation burden, improved work efficiency and patient communication, and enhanced job satisfaction among primary care physicians (PCPs). Findings showed that the use of medical scribes was associated with significantly reduced time in EHR documentation, and improvements in productivity and job satisfaction. Overall, the use of medical scribes could potentially improve physician workflow and, consequently, reduce physician burnout.

Methods

• Researchers conducted this 12-month crossover study with two sequences and four periods from July 1, 2016, to June 30, 2017, in two medical center facilities within an integrated health-care system.
• A total of 18 of 24 eligible PCPs (women: 10; internal medicine physicians: 12, family practice physicians: 6) were randomized to begin the initial 3-month period with or without scribes and, thereafter, alternated exposure status every 3 months for 1 year, thereby serving as their own controls.
• At the end of each study period, the PCPs completed a six-question survey.
• After scribed clinic visits, patients of participating PCPs were surveyed.
• Main outcomes and measures analyzed were PCP-reported perceptions of documentation burden and visit interactions, objective measures of time spent on EHR activity and required for closing encounters, and patient-reported perceptions of visit quality.

Results

• PCPs graduated from medical school a mean (SD) of 13.7 (6.5) years prior to the study start date.
• Scribed periods were related to less self-reported after-hours EHR documentation (< 1 hour daily during week: adjusted odds ratio [aOR], 18.0 [95% CI: 4.7-69.0]; < 1 hour daily during weekend: aOR, 8.7; 95% CI: 2.7-28.7) vs nonscribed periods.
• In addition, scribed periods were related to higher likelihood of PCP-reported spending > 75% of the visit time interacting with the patient (aOR, 295.0; 95% CI: 19.7 to > 900) and < 25% of the visit time on a computer (aOR, 31.5; 95% CI: 7.3-136.4).
• By the end of the next business day during scribed periods, encounter documentation was more likely to be completed (aOR, 2.8; 95% CI: 1.2-7.1).
• An aggregate of 450 of 735 patients (61.2%) reported that scribes had a positive bearing on their visits.
• Only 2.4% reported a negative bearing.